How sweet is the pacemaker?

Pacemaker infections can be difficult to diagnose, especially when they present with non-specific symptoms and signs a long time after insertion of the device. Unidentified or partially treated low-grade chronic sepsis can result in multisystem disease processes with significant mortality and morbidity. Therefore, a high index of suspicion is required to identify the pacemaker as the source of sepsis and treat it effectively. This report describes a case of chronic pacemaker wire infection, which eventually presented with Sweet's syndrome, a rare manifestation of infective endocarditis.

An unusual but reversible cause of ventricular fibrillation.

A 61-year-old woman was admitted with general malaise, chest pain and breathlessness. During her inpatient stay she sustained a ventricular fibrillation (VF) arrest which was successfully terminated with direct current cardioversion. Cardiac investigations revealed poor left ventricular systolic function but unequivocally normal coronary arteries. During the course of her admission a macular rash developed and following investigations including a renal biopsy, a new diagnosis of systemic lupus erythematosus (SLE) and related myocarditis was reached. First presentation of lupus with myocarditis and VF is uncommon, however reaching the correct diagnosis is important as due to the reversible nature of the condition and improvement in left ventricular systolic function with medical therapy, an implantable cardioverter defibrillator (ICD) might not be appropriate. Our case report demonstrates the importance of screening for reversible conditions when considering ICD therapy for secondary prevention of malignant arrhythmias.

Attitudes of 'tomorrow's doctors' towards psychiatry and mental illness.

BACKGROUND: Attitudes to psychiatry and mental illness among medical undergraduates are key factors in determining their choice of psychiatry as a career and willingness to deal with psychiatric disorders in general practice. METHODS: The responses of 108 medical students from the first and fourth year batches not exposed to psychiatry were compared with those of 139 final year students and interns who had completed varying components of psychiatric training using validated questionnaires that assessed their attitudes to psychiatry and mental illness, and their interest in psychiatry as a career choice. RESULTS: A greater proportion of students exposed to psychiatric training endorsed positive attitudes to mental illness than those not exposed (odds ratio=0.4; 95% confidence intervals: 0.21-0.71; p=0.002). The overall attitude towards psychiatry did not differ between students before or after psychiatric education. Women students were more likely to consider a career in psychiatry (odds ratio=2.9; 95% confidence intervals: 1.36-6.21; p = 0.004), but the proportion of students of either gender wishing to pursue psychiatry as a career option did not differ significantly with psychiatric training. CONCLUSION: Psychiatric education positively influences the attitudes of medical students towards mental illness and some aspects of psychiatry but does not increase the number of students wishing to pursue psychiatry as a career. Urgent and radical changes in psychiatric education for undergraduate medical students are required to meet current and future requirements of medical personnel trained to deal with psychiatric disorders.

The validation of the Tamil version of the 12 item general health questionnaire.

The 12 item General Health Questionnaire (GHQ-12), increasingly used to screen for common mental disorders (CMD) in primary care, has been validated in different languages and cultures. However, the validity of the Tamil version has not been established. Consecutive patients, attending a primary health care centre in Vellore, rural Tamil Nadu, India, were screened for CMD using the Tamil version of the GHQ-12. The subjects were also interviewed using the Revised Clinical Interview Schedule (CIS-R). The International Classification of Diseases-10: Primary care version (ICD-10 PHC) criteria were used to diagnose CMD. Various thresholds of the GHQ-12 were compared against the standards of the ICD-10 PHC. A receiver operator characteristic curve was drawn to obtain the best threshold value for screening. Principal Component Analysis was done to identify latent variables. The Cronbach's alpha and the split half reliability were also calculated. One hundred and eleven (33%) subjects of the 327 patients interviewed satisfied ICD-10 PHC criteria for CMD. The optimal threshold for the GHQ-12 was 2/3. This threshold had a sensitivity 87.4% and a specificity of 79.2%. Three factors were extracted with eigen values of 5.0 (depression-anxiety), 1.7 (social performance) and 1.1 (self-esteem) which explained 42.0%, 13.9% and 9.2% of the variance. The Cronbach's alpha was 0.86 while the split half-reliability was 0.83. The sensitivity and specificity of the Tamil version of the GHQ-12 is high. The factor structure is similar to that reported in other populations. The instrument can be employed as a screening instrument in this population.